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08/18/2010 13:27 FAX 9529335049 CULLIGAN MNTKA C�003
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<br /> FIXTURE BSMT 1 2 OTHER FTXTURE BSMT 1 2 O'IT�R
<br /> TYPE FL FL T'YPE FL FL
<br /> Water Closet Floor Drains
<br /> Lavatory . Sewer Ejector
<br /> Bathroom ' Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener I
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> � Yes,this section applies �
<br /> The replacement of a Residential fi�ure or aapiiance that meets all three of the following requirements:
<br /> 1. Does not require modification to electrical or gas service.
<br /> 2. Has a totaI cost of$500.00 or Iess; exclvdine�.he cost of the fucture or appliance: and
<br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor.
<br /> Skip next section,if this applies; Cost of Permit $ 15.00
<br /> . ' State Surcharge $ .50
<br /> Mail-In Fee(If Applicable) $ 1.50
<br /> Total Permit Fee $
<br /> (Permit Fees Continued On Next Pape)
<br /> 2
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